Children's Hospital Colorado

Transposition of the Great Arteries

What is transposition of the great arteries?

Transposition of the great arteries (TGA) is a congenital heart defect that occurs when a baby's heart develops incorrectly in the womb. This condition is marked by the reversal of the heart's two most important blood vessels, the aorta and the pulmonary artery.

In a healthy heart, the aorta pumps oxygen-rich blood to the body and the pulmonary artery sends blood to the lungs. This is where the blood absorbs oxygen so that the oxygen-rich blood can then be pumped to the body. With transposition of the great arteries, however, not enough oxygen-rich blood circulates from the lungs to the body.

The most common form of TGA

Most infants with transposition of the great arteries are diagnosed with "D-type" or dextro-transposition. In this congenital abnormality, no oxygen-rich blood goes to the body and:

  • The aorta and pulmonary artery are switched, but the ventricles developed in the correct place.
  • Blood that returns to the heart from the body travels from the right atrium to the right ventricle, where it is pumped out to the body again, without ever going to the lungs.
  • Blood from the lungs comes back to the left atrium and then to the left ventricle, where it is pumped back out to the lungs through the pulmonary artery.

Who is at risk of transposition of the great arteries?

TGA is a very rare congenital heart defect. Boys are more susceptible to D-type transposition, although the reason is not known. Children with a family history of transposition are also more likely to develop the condition.

Helpful resources

To learn more about transposition of the great arteries, visit The American Heart Association.

What are symptoms of transposition of the great arteries?

Transposition of the great arteries is a rare, critical birth defect in which the two main arteries of the heart (the aorta and the pulmonary artery) are reversed. The switching of the arterial position changes the way blood flows through the heart, resulting in a dangerous shortage of oxygenated blood going to the baby’s body. Without an adequate supply of oxygen to the body, serious complications and even death can occur.

The most common symptom of transposition of the great arteries is cyanosis, which is a blue tint to the skin caused by lack of oxygenated blood.

Other signs of transposition of the great arteries include:

  • Trouble breathing
  • Clubbed feet and toes
  • Poor feeding
  • Sweating during feeding

Can doctors detect the condition before a baby is born?

Prenatal ultrasound can identify babies with transposition of the great arteries (TGA) early in a mom's pregnancy. Prenatal detection is important because babies with TGA should be delivered at a high-risk center and they will need surgery soon after birth.

How do doctors diagnose transposition of the great arteries after birth?

Transposition of the great arteries in infants is usually diagnosed shortly after birth. Babies with the condition often have a blue tint to their skin, a sign of cyanosis caused by the lack of oxygen-rich blood in the body.

If your doctor suspects your child has TGA, he or she will order further tests. These will help a cardiologist identify the condition and evaluate its severity.

Common tests include:

Treatment for transposition of the great arteries

At Children's Colorado, our pediatric cardiologists and heart surgeons begin treating transposition of the great arteries right after birth.

Transposition of the great arteries treatments include:

Medication

If your child is born with D-type transposition, he or she may require medication and surgery very soon after birth. Most often, children are treated in the intensive care unit with intravenous (IV) medication and oxygen. Sometimes a breathing tube may be necessary for a short time.

If the hole between the atria (atrial septal defect) is not large enough, a minor procedure called an atrial septectomy or Rashkind procedure may be necessary to widen it so oxygen-rich and oxygen-poor blood can mix inside the heart. This is usually performed in the intensive care unit by your child's cardiologist.

Surgery

The only treatment for D-type transposition of the great arteries is heart surgery. The best and most common surgery is the arterial switch procedure, which is performed by pediatric cardiac surgeons. During this surgery, the pulmonary artery and aorta are switched back to their normal positions and the coronary arteries and large blood vessels are also switched. Any holes in the heart will also be repaired.

What are the expected outcomes for children with transposition of the great arteries?

After surgery, most children with transposition of the great arteries go on to live normal, healthy lives, but should be followed by a cardiologist for some time after surgery.

Learn more about pediatric heart surgery at Children's Colorado.

See why our outcomes make us one of the top heart hospitals

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